Table 2.

Activities of a Rapid Response Team (RRT) for cholera outbreak investigations.

At health facility	Review/collect data on suspected cholera patients per case definition.
	Review/collect data on patients treated for acute watery diarrhea.
	Assess health facility personnels' understanding on cholera and treatment protocols.
	Make inventory of supplies: specimen collection kits, rehydration supplies, etc.
At community	Interview patients and their families: confirm information on cases, track contracts, and identify risk factors.
	Interview any other ill persons suspected with cholera in the community.
	Interview to assess recent travel history, contacts with suspected cholera cases or/and ill persons with diarrhea, recent attendance at a funeral (and cause of death of deceased), water sources (drinking, bathing, cleaning kitchen utensils), food consumption history, occupation.
Specimens and lab tests	Collect 5–10 rectal swabs (if health facility has not performed) per outbreak/Woreda.
	Do not delay treatment of dehydrated patients to collect specimens.
	Obtain specimens before antibiotic therapy begins.
	Specimen collection within 5 days of onset of illness recommended.
	Arrange transport of rectal swabs to Regional Reference Laboratories and National Reference Laboratory at EHNRI (EPHI).
	Confirm cholera: identify strain, biotype, serotype, antibiotic sensitivity.
Data analysis	Review following information from register: name, age, sex, address, symptoms, date of onset of illness, date treated, treatment provided, treatment outcome (alive, dead, referred), specimen collection status, any risk related data, index case tracing.
	Geographical mapping of cases.
	Graph to visualize daily and accumulated cases per onset of illness.
	Analyse number of cases, deaths, attack rate (AR), case fatality rate (CFR), high risk groups, source of infection, etc.
	Analyze epi-curve to assess if an outbreak is on increase.
	Monitor Weekly Incidence Rate (WIR): i.e., high WIR as a proxy indicator of epidemic and speed of epidemic spread.
Treatment	Ensure treatment of suspected cholera or confirmed cholera patients per treatment guideline.
	Review case management at health facility: i.e., high CFR as a proxy indicator for the need to improve case management.
	Ensure availability of supplies for adequate patient treatment and specimen collection at health facility.
	Set-up a system to provide support for treatment in remotely located communities.
	Provide community health workers with Oral Rehydration Solutions (ORS).
Outbreak control	Conduct on-site control measures to prevent further transmissions linked to any identified source of infection.
	Communicate and sensitize communities and high-risk groups with simple health education messages.
Report and	Report outbreak investigation results and actions taken.
follow-ups	Follow-up surveillance visit(s).

Reconstructed based on the Guideline on Cholera Outbreak Management Ethiopia, Ethiopia Health and Nutrition Research Institute [EHNRI (now EPHI)], 2011.

RRT, Rapid Response Team; EHNRI, Ethiopia Health and Nutrition Research Institute; AR, Attack Rate; CFR, Case Fatality Rate; WIR, Weekly Incidence Rate; ORS, Oral Rehydration Solutions.